Provider Demographics
NPI:1053327056
Name:LOVELACE, DONNA K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:K
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3772 BERTROSE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2645
Mailing Address - Country:US
Mailing Address - Phone:817-437-0393
Mailing Address - Fax:
Practice Address - Street 1:3772 BERTROSE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2645
Practice Address - Country:US
Practice Address - Phone:817-437-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1671489-01Medicaid